Skip to Main Content
 

Global Search Box

 
 
 
 

Files

File List


Seicean_Dissertation_April2.pdf (697.4 KB)

ETD Abstract Container

Abstract Header

Risk, Outcomes, and Costs in Neurosurgery – The New Frontier in Health Services Research

Seicean, Andreea
http://rave.ohiolink.edu/etdc/view?acc_num=case1365082448

Abstract Details

2013, Doctor of Philosophy, Case Western Reserve University, Epidemiology and Biostatistics.
Introduction: Health services research driven from within neurosurgery can be used to improve access to and quality of care, while helping to control costs. Aim: To answer clinically relevant questions that make a difference in patient care. Methods: We chose to use the American College of Surgeons National Safety and Quality Improvement Project as the database for all components of this dissertation, which contains prospective, blinded, multi-institutional information about patients undergoing surgery. Results: Hemostasis history was as predictive as laboratory testing for all outcomes, with higher sensitivity. Advanced age does not increase the risk of poor outcomes after surgical resection of primary or metastatic intracranial tumors, after controlling for other risk factors. We not find smoking to be associated with early (30-day) peri-operative morbidity or mortality. All levels of anemia were significantly associated with prolonged length of hospitalization and poorer operative or 30-day outcomes in patients undergoing elective spine surgery. Conclusions: Routine hemostatic laboratory screening appears to have limited utility. Testing limited to neurosurgical patients with a positive history would save an estimated $81,942,000 annually. Age should not be used, in isolation, as an a priori factor to discourage pursuing craniotomy. Smoking cessation can be considered prior to spine surgery for reasons other then early (30-day) peri-operative morbidity or mortality. Anemia should be regarded as an independent risk factor for peri-operative and post-operative complications that deserves attention prior to elective spine surgery.
Duncan Neuhauser , PhD (Committee Chair)
Paul Jones, PhD (Committee Member)
Michael Kattan, PhD (Committee Member)
Robert Weil, MD (Committee Member)
143 p.
Epidemiology; Health Care; Health Sciences; Neurosciences; Surgery
neurosurgery; health services research; outcomes; cost; morbidity; mortality; craniotomy; tumor; hemostasis; screening; elderly; spine; treatment; prognosis; smoking; anemia

Recommended Citations

Citations

  • Seicean, A. (2013). Risk, Outcomes, and Costs in Neurosurgery – The New Frontier in Health Services Research [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1365082448

    APA Style (7th edition)

  • Seicean, Andreea. Risk, Outcomes, and Costs in Neurosurgery – The New Frontier in Health Services Research. 2013. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1365082448.

    MLA Style (8th edition)

  • Seicean, Andreea. "Risk, Outcomes, and Costs in Neurosurgery – The New Frontier in Health Services Research." Doctoral dissertation, Case Western Reserve University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=case1365082448

    Chicago Manual of Style (17th edition)

case1365082448
1,146
© 2013, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.